Treatment tailored to specific patient characteristics will have a significant positive impact on the delivery of healthcare. Using individual characteristics to effectively manage musculoskeletal pain syndromes is particularly intriguing because these conditions are commonly experienced and a burden to society. Promising information obtained from basic and pre-clinical pain research has not been translated into clinical settings to improve the management of musculoskeletal pain. This R01 Award will provide the resources for a multidisciplinary research team to investigate how pain-related psychological and genetic factors lead to the development of chronic musculoskeletal pain. Our primary hypothesis is that subjects with psychological and genetic risk factors will be more likely to exhibit elevated experimental pain sensitivity, resulting in a) increased exercise-induced shoulder pain and b) development of post-operative chronic shoulder pain. We have assembled promising preliminary data and will investigate our predictive model in two separate cohort studies that use the same psychological and genetic markers, but different pain models. This design is innovative because it allows us to investigate mechanisms involved with development of chronic pain in a controlled setting, as well as to determine whether these same risk factors have a clinically meaningful impact on post- operative shoulder pain. The ultimate goal of this line of research is to offer individualized musculoskeletal pain management based on a patient's psychological and genetic make up. This proposal represents an important first step in this process, as we will determine if the selected psychological and genetic risk factors allow for early and accurate identification of the development of chronic shoulder pain. This line of study will eventually allow us to a) conduct future randomized trials to determine if individualized treatment based on psychological and genetic risk profiles decreases the probability of developing chronic shoulder pain and b) study this predictive model in other commonly experienced musculoskeletal pain conditions (i.e. back and knee pain). PUBLIC HEALTH RELEVANCE Chronic shoulder pain is a prevalent and disabling problem for society. Promising information obtained from basic and pre-clinical studies has not been tested in clinical settings to determine if early and accurate identification of individuals likely to develop chronic shoulder pain is possible. The purpose of this study is to investigate whether psychological and genetic risk factors can be used to determine whether the development of chronic shoulder pain is likely to occur.